| NPI | 1699426791 |
|---|---|
| Other Name | COLLEGE STREET CAMPUS HEALTHY KIDS CLINIC |
| Entity Type | Organization |
| Authorized Contact | ERIC E LOY CEO 270-858-6655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2022-01-11 |